MEDICARE: DR. JEAN E BIRMINGHAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	R1P89	MO

General Provider Information

NPI Number	:	1063475523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN E BIRMINGHAM M.D.

Provider Business Mailing Address
First Line	:	1600 S BRENTWOOD BLVD
Second Line	:	SUITE 100
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-1320
Country	:	US
Telephone Number	:	314-918-8827
Fax Number	:	314-918-9391

Provider Business Practice Location Address
First Line	:	1600 S BRENTWOOD BLVD
Second Line	:	SUITE 100
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-1320
Country	:	US
Telephone Number	:	314-918-8827
Fax Number	:	314-918-9391

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	07/08/2007

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